EP2482754A1 - Procédés, systèmes, appareils et dispositifs de diagnostic dentaire et de restauration dentaire - Google Patents

Procédés, systèmes, appareils et dispositifs de diagnostic dentaire et de restauration dentaire

Info

Publication number
EP2482754A1
EP2482754A1 EP10821246A EP10821246A EP2482754A1 EP 2482754 A1 EP2482754 A1 EP 2482754A1 EP 10821246 A EP10821246 A EP 10821246A EP 10821246 A EP10821246 A EP 10821246A EP 2482754 A1 EP2482754 A1 EP 2482754A1
Authority
EP
European Patent Office
Prior art keywords
aiming
root
furcated
dimensional model
natural
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP10821246A
Other languages
German (de)
English (en)
Other versions
EP2482754A4 (fr
Inventor
Gunnar Hasselgren
Anas Selman
Chia-Yi Chen
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Columbia University of New York
Original Assignee
Columbia University of New York
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Columbia University of New York filed Critical Columbia University of New York
Publication of EP2482754A1 publication Critical patent/EP2482754A1/fr
Publication of EP2482754A4 publication Critical patent/EP2482754A4/fr
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/20—Methods or devices for soldering, casting, moulding or melting
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C13/00—Dental prostheses; Making same
    • A61C13/0003—Making bridge-work, inlays, implants or the like
    • A61C13/0004—Computer-assisted sizing or machining of dental prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61C—DENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C8/00—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools
    • A61C8/0018—Means to be fixed to the jaw-bone for consolidating natural teeth or for fixing dental prostheses thereon; Dental implants; Implanting tools characterised by the shape
    • A61C8/0036—Tooth replica
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B33—ADDITIVE MANUFACTURING TECHNOLOGY
    • B33Y—ADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00—Products made by additive manufacturing
    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
    • G16H20/40—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture

Definitions

  • the implant model may be computationally adjusted based on a prediction of an amount of periodontal ligament to remain in the socket after root extraction, for example, by contracting the implant model from the dimensions of the bone by a predefined distance or by imaging the soft tissue. Full or partial removal of the periodontal ligament may also be provided in a suitable method.
  • the model of the implant may be rendered into an implant by any suitable means. In a particular embodiment, a wax cast is machined and a mold created from the machined part to create a titanium (or alloy of titanium) casting whose surface roughness is well adapted to biointegration.
  • a portion of the periodontal ligament can be retained in the socket and the model is modified to accommodate it.
  • a predicted reduction of the size of the implant model is made to account for the thickness of the ligament.
  • the implant is formed from the model such that when implanted, except for the access to the socket, it is entirely encased in bone. As such, after implantation, bone may grow over the top of the implant.
  • an implant is fabricated according to any of the disclosed embodiments and implanted. After a healing period, for example, three weeks or more, an abutment and a restoration element are fabricated using CAD or impression-based techniques or a
  • the restoration element and/or abutment may be prefabricated and form members of a kit having a range of alternative sizes and shapes permitting a selected one to be chosen as a best-fit to the patient's current or predicted anatomy - the term "anatomy" being used herein to identify any artificial or natural anatomical features.
  • the method of use may further include the replacement of the abutment, and/or restoration, at a later time to improve the fit with the anatomy, for example after a period of time in which a shift occurs due to other changes in anatomy resulting from surgery or natural changes due to wear, aging, growth, or other reasons.
  • the method may comprise fabricating a model of a natural furcated root and forming, responsively to the model, an implant whose sides are shaped substantially as the natural root but with an end that has a shallower recess between the furcations than the natural furcated root.
  • the model may be a faithful copy of the root of a tooth whose extraction is planned.
  • the model may alternatively be a faithful copy, or a prediction derived from an image, of a natural tooth socket.
  • the fabricating may include generating a numerical model of the implant and adding volume to the model such as to reduce the depth of the recess between the furcations.
  • the disclosed subject matter also relates generally to dental radiographic imaging.
  • the procurement of radiographs using specific, standard, and/or reproducible angles may be desirable to provide one or more additional, "supplemental" radiographs from perspective angles different from the angle of the first taken radiograph (e.g., the orthogonal radiograph).
  • supplemental radiographs can enhance visualization and evaluation of the three-dimensional structure of the object or objects.
  • Radiographs taken at specific, standard, reproducible angles can lead to an increase in patient safety because the number of radiograph re-takes will decrease, thereby exposing the patient to less radiation during the imaging process.
  • An aiming apparatus can be used to obtain the specific, standard, and/or reproducible angles.
  • angles may be chosen to provide satisfactory image information to allow computation of a representative three-dimensional mathematical model of a target, such as a tooth.
  • a predicted range of shapes of the target can allow such three- dimensional models to be derived from a small number of images, for example, two.
  • the disclosed subject matter includes a method, apparatus, and/or system for taking radiographs.
  • a first radiograph is taken with the aiming direction forming a first angle with the normal to an image plane of the image receptor.
  • the aiming direction may be parallel to the normal of the plane of the image receptor (orthogonal angle).
  • a second radiograph may be taken with a different aiming direction.
  • the angular space between the aiming directions can range from ten degrees to twenty-two degrees.
  • the radiograph taken with the multiple aiming angles may be used to create a three-dimensional image of an object represented by the radiographs using techniques such as described in U.S. Patent Nos. 6,816,564 and 6,049,582 incorporated by reference in their entireties.
  • the aiming directions can be equally spaced from the normal to the plane of the image receptor.
  • one aiming direction can be aligned with the normal and one can be oblique to the normal of a planar image receiver.
  • the angle (or angles) between the aiming directions may lie in a plane that is approximately normal to a tooth root axis.
  • the angular separation between multiple aiming directions may include ones that lie in the plane that is approximately normal to a tooth root axis and components that lie in a plane that is oblique or parallel to a tooth root axis,
  • the aiming device may be provided with a support member adapted to fixedly position and orient the aiming device with respect to dental anatomy of a patient.
  • the aiming rings may be provided with a support boss with a hole.
  • the hole may be shaped to receive a support arm extending from a bitewing bite block or other type of support.
  • the hole may have a polygonal or other shape for receiving a support arm with a similar shape. The polygon or other shape may be selected to secure against undesired rotation about the support arm axis.
  • a kit of rings each defining different aiming angles with respect to the support arm, and thereby the target anatomy.
  • Each of the rings defines an angle, with reference to the arm, such that the aiming directions are separated by the angles predetermined to be suitable for forming, when synthesized using a computer, a three-dimensional model of the target tooth.
  • FIGs. 1 A and 1 B illustrate a procedure for creation and placement of a dental prosthesis according to embodiments of the disclosed subject matter.
  • Fig. 1 C shows a finished implant according to embodiments of the disclosed subject matter.
  • Fig. 1 D is an illustration of a socket with tissue at the base of the socket, possibly including alveolar bone, removed to accommodate an implant according to embodiments of the disclosed subject matter.
  • Fig. 2A is an exploded view of the parts of dental prosthesis according to embodiments of the disclosed subject matter.
  • Fig. 2B is an assembled view of a dental prosthesis according to embodiments of the disclosed subject matter.
  • Fig. 3 illustrates a bridge affixed by implants according to
  • Fig. 4A is an illustration of a socket to accommodate an implant according to embodiments of the disclosed subject matter.
  • Fig. 4C is an illustration of a socket to accommodate a convex implant according to embodiments of the disclosed subject matter.
  • Fig. 5A shows an incisor in section.
  • Fig. 5B shows, in partial section, an implant/dental prosthesis for use where the thickness of the bone supporting the implant is relatively thin according to embodiments of the disclosed subject matter.
  • Figs. 6A, 6B, 6C, and 6D illustrate an implant/dental prosthesis for use where the thickness of the bone supporting the implant is relatively thin according to further embodiments of the disclosed subject matter.
  • Fig. 8A is a perspective view of an aiming apparatus which may be used as part of a radiographic system according to embodiments of the disclosed subject matter.
  • Fig. 8B is a plan view of the aiming apparatus of Fig. 8A coupled in a first position to a bitewing image receptor support, the combination of which may be used with a radiographic imagine system according to embodiments of the disclosed subject matter.
  • Fig. 8C is a plan view of the aiming apparatus of Fig. 8A coupled in a second position to a bitewing image receptor support, the combination of which may be used with a radiographic imagine system according to embodiments of the disclosed subject matter.
  • Fig. 9 is a plan view of a multi-direction aiming apparatus similar to the embodiment of Figs. 8B and 8C defining three aiming directions.
  • Figs. 12A and 12B illustrate members of a kit of single-ring aiming apparatuses according to embodiments of the disclosed subject matter.
  • Figs. 1 A and 1 B illustrate a procedure for creating and placing a dental prosthesis.
  • a patient may visit a dental facility for a dental evaluation by a dental clinician.
  • the clinician may take one or more radiographs of the patient's teeth and surrounding structure. Examination of the radiographs can identify problems with one or more of the patient's teeth and/or surrounding structure. In certain instances, the problems may require removal of one or more of the patient's teeth. If a tooth is not replaced after extraction, one or more of the patient's remaining teeth may move because of the additional space. Such movement can lead to problems, such as bite alteration and speech issues.
  • An extracted tooth and/or root may be replaced by a dental prosthesis to fill the void left by the extracted tooth and/or root and replace the function of the extracted or missing tooth.
  • data representing the tooth, tooth root, and/or surrounding structure, such as the socket and bone shape may be acquired 122.
  • the target anatomy may be scanned via radiographic three-dimensional imaging prior to extraction, or multiple planar images may be used to synthesize a three-dimensional model of the target surface or surfaces as indicated at 124.
  • One or more two-dimensional X-ray images can be taken, for instance.
  • Radiography methods include tomography techniques, computed tomography ("CT") techniques, and cone beam CT techniques. MRI techniques may also be used. Impression techniques may also be used. Other devices and techniques may also be used such as optical coherence interferometry, ultrasound, terahertz wave imaging, and extraction and mechanical or laser scanning. Combinations of any of the above techniques may be used.
  • CT computed tomography
  • MRI computed tomography
  • Impression techniques may also be used.
  • Other devices and techniques may also be used such as optical coherence interferometry, ultrasound, terahertz wave imaging, and extraction and mechanical or laser scanning. Combinations of any of the above techniques may be used.
  • the modifying may include the creation of a conforming convex surface such as might be illustrated by the stretching of a fabric over three dimensional object with concave surfaces.
  • model 108 with a non- furcated root structure can be created.
  • the three dimensional model or template 108 is created based on a furcated natural tooth root having a recess between the branches of the root furcation, wherein the computer software reduces a depth of the recess by adding volume to the template.
  • the resultant model 108 shows a fully filled-in volume between the roots, resulting in a model with non-furcated root structure.
  • Various algorithms may be applied for the filling in of furcations and other modifications of the model, such as a surface spline fit with a minimum smoothness constraint.
  • the CAD software can modify the natural three-dimensional model of the tooth and/or tooth root(s). For example, some or all of the volume of the recessed portion or void can be filled-in to create a modified image or model.
  • a three- dimensional image or model of a portion of the dental prosthesis is generated 128.
  • the model or image can be created using computer software, and the portion of the dental prosthesis created at this point can be the implant 1 10, an abutment for coupling to the implant (not explicitly shown), and/or a crown 1 12 for coupling to the abutment.
  • Fig. 1 A shows a model of the dental prosthesis with the implant portion 1 10, abutment portion (not shown), and the crown portion 1 12.
  • Software may calculate the load applied to one or more portions of the prosthesis during different jaw movements, for example. Such calculations can aid in designing the one or more portions of the prosthesis to obtain optimal stress distribution.
  • the implant is fabricated using any suitable technique.
  • a corresponding abutment and crown also can be created.
  • the implant can be created in a lab or at a treatment location.
  • data representing the three-dimensional model of the implant can be transmitted to a lab and used to fabricate the implant which can then be shipped to the clinician at a treatment location.
  • Fig. 1 A, at 130-146 illustrates an embodiment in which a casting technique is used to fabricate the implant. Casting can provide for a customized fit, which theoretically leads to better implant-to-bone integration (osseointegration), as well as fewer infections and complications.
  • a casting model 1 14 of the implant is created in software at 130.
  • the casting model 1 14 can have a handle 1 13, which can be used for handling of the casting model 1 14 and which may be removed by machining.
  • a material is cast in the mold 134 of the model 136 at 146.
  • a desirable material is pure titanium or alloy thereof that has been heated to liquefaction in an oxygen-free environment by induction heating, for example, wherein the oxygen-free environment may be created by purging with an inert gas such as argon gas.
  • the cast implant 138 may be inspected for imperfections after the casting. Though not explicitly shown in the casting at 146, the implant may be cast in a ready-to-place form, with no additional milling or other physical alterations necessary before placement.
  • Features to permit the attachment of an abutment and/or a crown can be provided by the wax model, such as a supporting surface and/or a threaded recess.
  • the implant is then sterilized and made ready for placement in a socket, for example, the socket of a newly extracted tooth.
  • a handle 1 13 may be removed before preparation of a receiving portion configured to mate to an abutment and/or a crown.
  • the implant 139 may be machined to create features to permit the attachment of an abutment and/or crown at 148.
  • the implant 139 may be machined to form a supporting surface such as a recess 140 which may be a socket shaped feature.
  • a threaded recess 141 may formed by drilling and tapping.
  • the abutment is attached, by a bolt or screw, to the
  • the implant 139 also can be created by milling using a milling apparatus based on a milling model (not shown).
  • the milling apparatus can perform the milling by a number of methods, such as laser milling, cutting, grinding, chemical etching, or other techniques.
  • techniques such as three-dimensional printing lithography, or photopolymerization can be used to create a degradable model that can be used to create a mold. Note that as stated elsewhere, an intermediate wax model with casting is only one alternative and other fabrication techniques may be used.
  • the implant 139 can also be provided with surface augmentation features, such as studs, pits, striations, etc. These may be provided at the model generation phase 128 or at another stage by suitable additional fabrication steps.
  • the implant 139 may have prepared channels formed therein, wherein the channels may be perpendicular to the long axis of the implant and close to the apex, away from the oral cavity.
  • Such surface augmentation can be beneficial for bone growth into, on, and around the surface augmentations.
  • the surface augmentation also may assist with retention of the implant 139 in the socket.
  • Another type of augmentation may be the provision of one or more through-holes as described below with reference to Fig. 7 to allow bone to grow deeply into the implant.
  • the patient may return to the clinician's office for a second visit, at which time, if not acquired at a prior visit, or in addition to data acquired at a previous visit (e.g., when creating the implant model), data for creation and/or placement of a suitable crown and/or abutment may be collected 150.
  • data may include various patient anatomical information, such as adjacent tooth position, spacing, etc.
  • the alveolar bone portion 164 filling the space between the roots can be shaped or otherwise modified to create a modified tooth socket 162.
  • the socket 162 may be "shaped" to conform to the implant 139 to be placed.
  • Fig. 1 D shows an alveolar bone 164 and surrounding tissue between a furcated root structure that may be removed. Some or all of this bone tissue may be removed before placement of the implant.
  • a special tool may be used to remove some or all of the bone, such as a rongeur, bone forceps, a drill, etc. The special tool can be configured to modify the socket based on the configuration of the implant to be placed therein.
  • the special tool can be used to create a precise interface for the bottom of the socket and the bottom of the implant.
  • the bottom of the implant to be inserted may be substantially flat for a socket bottom that has been modified or is otherwise substantially flat, such as shown in Fig. 4A.
  • the special tool also can be used to create a support feature in the socket, preferably at the bottom.
  • Figs. 4A-C show examples of manners in which the socket can be shaped or modified to mate with a conforming shape of a modified implant.
  • Fig. 4A is similar to Fig. 1 D, with the entire alveolar bone portion having been removed from socket 502.
  • Fig. 4B shows socket 510 with a small portion of the alveolar bone remaining in the form of a protrusion or a stub 512. The portion of the alveolar bone left remaining may be used to anchor or otherwise retain an implant with a concave bottom portion to the socket 510.
  • the entire alveolar bone portion has been removed from the socket 520, and a portion of the bone tissue below has been removed, creating a recess 522.
  • This recessed portion 522 in the bone tissue may be used to anchor an implant with a convex bottom portion to the socket 520.
  • a retaining member 534 extends into the recessed portion in the bone tissue for anchoring the implant 544.
  • the retaining member 534 may be a stud or screw that is pushed or threaded through a hole 532 in an implant 544.
  • a recess that mates with an abutment is indicated at 536.
  • the implant 139 may be emplaced 154.
  • Data for creating and positioning of an abutment and/or a crown can be obtained at this time (e.g., additional imaging data). From the data taken with the implant and healing, if any, an abutment and/or crown can be modeled and created.
  • the implant 139 can be directly loaded with a crown, temporary or permanent.
  • the implant 139 may be emplaced, including being enclosed by overlying soft tissue, for a healing interval 154.
  • the implant 139 may be fabricated to lie below the bone line such that bone is permitted to grow over the top of the implant 139.
  • an implant 139 is arranged below the bone line 180, 184.
  • the implant 139 may be made so that a top surface thereof, or a part of the top surface, lies below the bone line. This may enhance the strength of the implant and also help in healing because the implant 139 can be more easily covered (temporarily) by soft tissue.
  • the implant may be sized so that when healing occurs, the top is partially covered by bone. Before attaching the abutment, the top portion of the implant 139 may be covered partially or completely by soft tissue to assist with healing.
  • the implant is covered by soft tissue during healing, wherein only the implant 139 is emplaced, the implant 139 later may be permanently restored with a crown that is connected to the implant via an abutment with a screw 206.
  • the abutment may be fabricated or selected from a kit after the healing interval.
  • Figs. 2A and 2B show exploded and assembled views of a dental prosthesis according to embodiments of the disclosed subject matter.
  • the dental prosthesis includes an implant 139, an abutment 212, and a crown 202.
  • the implant 139 includes a receiving opening or recess 140 to receive a mating feature 210 of the abutment 212.
  • the implant 139 also has a threaded recess 142 to receive a screw 206 used to secure the abutment 212 to the implant 139.
  • the abutment 212 may include a recess 208 into which the head of the screw 206 is recessed and upon a blind end of which the screw 206 head exerts a binding force.
  • the crown 202 may have a recess 204 that is configured to fit closely the abutment 212.
  • the crown 202 and abutment 212 may be configured for a snap-fit.
  • FIG. 3 illustrates a restoration including a bridge 302 that may be affixed to abutments located at various points such as indicated at 304.
  • the abutments in this case may be attached as described elsewhere herein, to implants as also described herein.
  • Presentment screw-type implants generally need to be placed in "solid bone,” where the bone is most dense, and permitted to osseointegrate.
  • placement of conventional screw-type implants can cause aesthetic and/or functional problems.
  • the thin facial bone structure the bone on the buccal side of the tooth
  • presentment screw type-implants can cause problems when placed close to the facial surface of the bone (e.g., in the upper front tooth region). Instead they must be placed further into the oral cavity, which makes restoration difficult both functionally and esthetically. Screwing the implant into the thin facial bone surface can crack the facial thin bone surface such that screw threads project from the bone surface. Such cracking can impair or prevent bone formation and ultimately lead to implant failure.
  • FIG. 5A shows an incisor in section and Fig. 5B shows, in partial section, an incisor prosthesis according to embodiments of the disclosed subject matter.
  • a natural tooth 402 is supported by bone 410 and 406 of the jaw.
  • a space where the natural periodontal ligament resides is also shown at 412.
  • the lingual 408 and buccal 404 surfaces of the adjacent gum are also indicated.
  • the bone 406 forming part of the jaw on the buccal side is thinner than the lingual side 410.
  • the features of Fig. 5A are shown for the example of an incisor, but it is possible for one portion of bone supporting a tooth to be thinner on one side than on another under other conditions, so the incisor is described merely as an example.
  • a restoration is placed in the bone in a more lingual position than the original socket such that a thicker layer of bone 420 on the buccal side is formed.
  • the new socket may be formed by reshaping the socket by machining and filling in a portion with bone, for example, by filling with a temporary implant with a porous element that integrates with bone such as metal sponge or coral. Promoters of osteogenesis such as hydroxyapatite may be used.
  • the socket may be filled-in completely with bone and a new socket formed by machining.
  • Fig. 5B illustrates a completed restoration with supporting bone 420 and 421 with a socket 414 into which an implant 413 has been implanted.
  • the implant 413 has a recess 428 which may be formed by machining along with a tapped threaded hole 417 with a screw 426 threaded thereinto.
  • An abutment 427 is shaped to fit closely in the recess 428 and therefore has a shaft 429 portion that extends into the recess 428.
  • the abutment 427 has a dome 422 to which the crown 430 is attached, for example by adhesive or cement.
  • the dome 422 is offset relative to the socket axis to place the crown 430 in a natural position with respect to the affected anatomy and gum surfaces 404 and 408.
  • a hole 424 provides access for a tool to a head of the screw 426.
  • the abutment 427 is configured to align a crown 430 to the surrounding anatomy.
  • abutments according to the present embodiments can provide for the placement of a crown 430 at different angles and positions by making changes to the abutment 427 without requiring replacement of the implant 413.
  • the abutment 427 may be customized based on a post-healing model (produced via post-healing imaging), or it can be customized based on the initial or an intermediate imaging.
  • Figs. 6A, 6B, 6C, and 6D illustrate an implant embodiment that has one side that is configured to permit and promote osseointegration, thereby forming a thicker layer of bone adjacent the tooth.
  • the implant can be used in conjunction with the offset abutment and an implant location positioned remotely from the natural axis of the socket, as described with reference to Figs. 5A and 5B.
  • a natural tooth root 602 is shown in axial section with bone 606 adjacent the buccal side of the tooth.
  • An implant 604 is about the size of the natural root 602 and has a recessed portion 612 in the buccal face thereof.
  • Standoffs 610 can be attached to the recess portion to help position the axis of the implant in the desired position and maintain spaces where bone can grow to help support the implant 604.
  • the standoffs 610 may be fabricated of a material that permits and/or promotes osseointegration.
  • the bone is shown after having grown into the recess portion 612 and integrated into the standoffs 610.
  • the standoffs 610 can be made from resorbing material (e.g., coral) or from metal foam. Alternatively, they may be integral portions of the implant.
  • the standoffs are elongate members parallel to the axis of the tooth rather than low aspect-ratio studs as depicted at 610. Other variations are also possible.
  • FIG. 7 illustrates an implant with a through-hole for anchoring an implant.
  • An implant 139 as described above with reference to Fig. 1 C has a through hole 702 formed in its side.
  • a model of the through hole 702 may be digitally formed in the 3D model and fabricated as part of the casting or milling process as described above.
  • One or more through holes may be formed.
  • a single hole of 4 mm in diameter, for example, may be provided, which is a size that will permit ingrowth of bone.
  • the one or more through-hole(s) 702 may be fully or partly filled with scaffold or osteogenic materials prior to implantation. Where multiple through- holes are provided, such holes may have crossing axes, for example, or parallel ones.
  • Existing fabrication technology may be used to control fabricating system based on the modified model. Modification of the three-dimensional model may be done manually.
  • the data of the modified model may be stored in a data store such as a random access memory, a nonvolatile data storage device such as a rotating disk or flash memory or it may be transmitted through a data channel to a remote computer that receives data for fabrication purposes, such as one at a dental laboratory.
  • a casting representing the shape of the root may first be made from the socket or an extracted root or tooth. Then the casting may be manually modified to eliminate or reduce the furcation by adding a material to fill in the recess.
  • the furcated casting could be inserted in a tight elastic "sock" and liquid curable resin injected into it so that concavities are filled in. The curable resin may then be cured leaving a modified model. The model may then be used to create a titanium or other casting according to known techniques.
  • An implant may be fabricated by other means as well.
  • the implant of any of the embodiments may be customized such that the surface details of a natural tooth root are represented in the implant with sub-millimeter precision.
  • an implant of the disclosed embodiments may be a naturally shaped implant with a solid body having a shape that conforms precisely to a uniquely- shaped furcated portion of a natural tooth root of a unique living patient.
  • the surface details of the implant may be preserved, with the tooth root having a recess that defines a furcation of the tooth root, the tooth root also having an external portion along a same axial extent of the tooth root as the recess, except that the furcation of the implant has a recess that is substantially reduced relative to the tooth root, or completely absent.
  • aspects of the disclosed subject matter assist with acquisition of X-ray images at specific, pre-set aiming directions for
  • Embodiments include devices that assist a dental clinician in establishing predefined aiming directions of a target that are reproducible and define multiple aiming directions.
  • the devices may be made so as to be autoclavable or disposable.
  • embodiments include devices that may be attached to, and used with, currently existing bitewing bit block supports.
  • Present embodiments may form components of a system in conjunction with a computer system and software to produce three-dimensional representations based upon radiographs of multiple angles.
  • Multiple-angle images for example, can be combined to create a three-dimensional model, and the model used to enable three-dimensional computer-aided fabrication of a dental prosthetic based on the model.
  • an aiming apparatus 800 is configured to assist alignment of a tube head of an X-ray apparatus such that X-ray beams are directed through a target at an image receptor at angles defined by the aiming apparatus 800.
  • the target may be a tooth or other animal anatomy.
  • the angles may be chosen to provide sufficient information for three-dimensional modeling from the resulting planar projections of the target.
  • the angles may be chosen also to minimize occultation (for example by adjacent anatomy such as an adjacent tooth or root) and may be chosen to be sufficient for the particular geometry.
  • the aiming apparatus 800 may be formed of a material that is relatively transparent to X-rays, such as a non-metallic material, for example, any of various suitable thermoplastics.
  • the aiming apparatus 800 may be formed of a single integral structure using techniques such as injection molding.
  • the aiming apparatus 800 may be formed in a single molding operation or formed from multiple elements that attached together to form a composite structure.
  • the aiming apparatus 800 may be autoclavable, reusable, or disposable. Mechanically, the aiming apparatus 800 may be "universal" in the sense that it can be configured to be compatible with other existing radiography instruments in the market, such as support arms, bitewing bite blocks, image receptors, and/or X-ray tube heads.
  • the aiming apparatus 800 includes a first ring 810 and a second ring 830.
  • the first ring 810 and the second ring 830 can be arranged as shown in Fig. 8A.
  • the rings 810, 830 may be substantially the same shape and size.
  • the first ring 810 may overlap the second ring 830 as shown.
  • the positions and angles of the rings 810, 830 are such that, when positioned on a bitewing bite block support (See Fig. 8B), the aiming axes 815, 835 intersect approximately at an image plane 1 102 of a radiographic imaging device 1 100.
  • first ring 810 has a body portion that defines an angle and position such that the X-ray tube head is aimed at a target.
  • a receiving member 818 Projecting from the first ring is a receiving member 818 which includes an aperture 820 through which a support arm 900 can be inserted.
  • the position of the receiving member 818 relative to the first ring 810 may be based on the configuration of a support arm 900, an image receptor 1 102, and/or a bite block device 1000 with which the aiming apparatus 800 is to be coupled.
  • the receiving member 818 is configured to receive a support arm 900 of an image receptor 1 100/bite block device 1000 (not shown in Fig. 8A).
  • the support arm 900 can be inserted through aperture 820, and the aiming apparatus 800 can be moved along the length of the support arm 900 to a desired position. Markings and/or detents may be provided on the aperture 820/support arm 900 combination to assist with positioning and/or retention of the aiming apparatus 800.
  • the aperture 820 can have any suitable shape in section, such as a square or other polygon.
  • the ring 810 may be held in position by friction or by locking engagement with the support arm 900.
  • the second ring 830 can be configured similar to the first ring 810 and attached to define an angle with respect to the first ring 810, for example, a separation angle of twenty degrees.
  • the receiving member 838 with aperture 840 projects from the second ring 830 and is configured to receive a support arm 900 of an image receptor 1 100/bite block member 1000.
  • the support arm 900 can be inserted through aperture 840 of the second ring 830, and the aiming apparatus 800 can be moved along the length of the support arm 900 to a desired position closer or further from the image plane 1 102 to accommodate a patient's anatomy.
  • receiving member 838 may overlap an open inner portion 822 of the first ring 810 such that access to aperture 840 is substantially unobstructed by the body of the first ring 810.
  • Markings and/or detents may be provided on the aperture 840/support arm 900 combination to assist with positioning and/or retention of the aiming apparatus 800.
  • Other positioning devices may also be used such as a linear positioner, slide-lock device, pantograph, or other device.
  • the rings 810, 830 are offset and canted with respect to each other such that the axes 815, 835 centered at openings of the rings intersect at the plane 1 102 of the image receptor 1 100.
  • the rings 810, 830 may be canted with respect to one another at angles predetermined to permit the creation of a three- dimensional representation.
  • the rings 810, 830 may be angled from above zero degrees to twenty-two degrees.
  • the rings 810, 830 may be angled with respect to one another from eleven to twenty-two degrees.
  • they may be canted with respect to one another at an angle from ten to twenty degrees.
  • the rings 810, 830 in Fig. 8A for example, are angled at twenty degrees with respect to one another.
  • the clinician can aim an X-ray apparatus, using the arrangement of the rings 810, 830 to take radiographs at the angles defined by the ring positions.
  • radiographs can be taken at predetermined, reproducible angles without requiring the clinician to move or otherwise reposition the aiming apparatus 800.
  • Either of the rings 810, 830 can be arranged such that a respective axis 815, 835, which passes through the center of the ring 810, 830 forms an orthogonal or substantially orthogonal angle with respect to a receiving surface 1 102 of an image receptor 1 100. Consequently, the axis of the other of the rings forms an oblique angle with respect to the receiving surface 1 102 of the image receptor 1 100.
  • the axes of the rings are both oblique to the image plane, for example, forming equal and opposite angles of the normal.
  • Fig. 8B is an overhead view of a radiographic system 801 with aiming device 800, a bite wing or block device 1000 coupled to the aiming apparatus 800 via a support arm 900, and an image receptor 1 100 coupled to bite block device 1000.
  • the aiming apparatus 800 is coupled in a first position to bite block device 1000 and image receptor device 1 100.
  • the bite block device 1000 can include a receiving portion 1002 to receive support arm 900.
  • the support arm 900 can be integral, or permanently attached to the bitewing bite block device 1000.
  • FIG. 8B shows support arm 900 being coupled to the receiving portion 1002 on the left side of the bitewing bite block device 1000 (in plan view), the receiving portion 1002 can be arranged on the right side of the bitewing bite block device 1000 (in plan view) or arranged below or above the bitewing bite block device 1000.
  • a plurality of receiving portions 1002 may be provided, each located at a different respective position (aiming angle) relative to the bitewing bite block device 900 to permit the selection of different positions and angles.
  • the particular arrangement of one or more of the receiving portions 1002 may be compatible with different shapes, sizes, and/or configurations of support arms 900.
  • the bitewing bite block device 1000 also may be configured with a base or stabilizer (not shown) to hold against an opposite tooth row. Such a configuration can stabilize the bitewing bite block device 1000 in the patient's mouth during imaging.
  • the image receptor 1 100 is coupled to the bitewing bite block device 1000.
  • the image receptor 1 100 may be a holder for supporting radiographic film or a variety of digital sensors to create the image on a digital medium or memory (not shown).
  • a digital-type image receptor may be configured to permit multiple radiographs to be taken without having to open the patient's mouth to gain access to the used film and to insert a new film element.
  • Support arm 900 can be coupled to bitewing bite block device 1000 via receiving portion 1002.
  • Support arm 900 is configured to slidably engage receiving members 818, 838 of the rings 810, 830.
  • Fig. 8B shows support arm 900 slidably engaged with receiving member 818 of first ring 810.
  • Receiving members 818, 838 of the rings 810, 830 may be moved or slid along the length of the support arm 900 to position the aiming apparatus 800.
  • the arm member 900 may have markings and/or detents (not shown) to assist with positioning and/or retention of the aiming apparatus 800.
  • markings and/or detents not shown
  • the markings and/or detents can be based on the particular angular configuration of the rings 810, 830.
  • the markings and/or detents may indicate a position along the support arm 900 at which to position the aiming apparatus 800 so that the axes 815, 835 of the rings cross at the image plane 1 102.
  • the markings and/or detents also can be arranged to take into consideration the particular configuration of the bite block device 1000, the image receptor 1 100, and/or the aiming apparatus 800.
  • the support arm 900 may have a non-round cross-section to prevent rotation of the supported aiming apparatus 800 (or other similar embodiments disclosed herein).
  • the aiming apparatus 800 may have receiving apertures 820, 840 that have a shape that engages with the cross-sectional shape of the support arm 900 such that rotation or pivoting about the support arm 900 is prevented.
  • a depth of the apertures 820, 840 (for example, a depth of the receiving member 818) may be such that it holds the aiming apparatus 800 at a precise orientation.
  • a tight frictional engagement may be provided such the aiming apparatus 800 is firmly held to maintain a predefined orientation.
  • the structure may be such that the aiming directions reliably cross as illustrated in Fig. 8B when the aiming apparatus 800 is attached to the support arm 900.
  • the aiming apparatus 800 shown in Fig. 8B is arranged in a "first" position, such that receiving member 818 of the first ring 810 is coupled to support arm 900 and such that receiving member 838 of the second ring 830 is free.
  • the axis 815, at the center of the first ring 810 can be orthogonal to, or substantially orthogonal to, receiving surface 1 102 of the image receptor 1 100.
  • the axis 815 may be directly in the center of the receiving surface 1 102, or it may be offset therefrom.
  • the axis 835, at the center of the second ring 830 can define an aiming axis that is orthogonal to the receiving
  • the X-ray head of the X-ray apparatus can be moved and aligned with the second ring 830 (manually by the clinician or otherwise) to output X-rays toward the object or objects to be imaged and the image receptor 1 100, based on the alignment of the second ring 830.
  • the order of use of the rings 810 and 830 may be reversed.
  • An electronic system can associate the angle (including the orthogonal angle) at which each radiograph was taken. This information may be stored electronically for use in generating a three-dimensional representation.
  • Fig. 8C is an overhead view of the radiographic system 801 in Fig. 8B, with the aiming apparatus 800 attached to the support arm 900 via the receiving member 838.
  • the receiving member 818 is free.
  • the axis 835 associated of the second ring 830 is orthogonal to or substantially orthogonal to receiving surface 1 102 of the image receptor 1 100.
  • the axis 815 at the center of the first ring 810 is at a non-orthogonal angle with respect to the receiving surface 1 102.
  • Fig. 9 is an overhead view of a radiographic system 801 having an aiming apparatus 800A coupled to the bite block device 1000 and image receptor 1 100.
  • the aiming apparatus 800A in Fig. 9 is configured to assist with alignment of a tube head of an X-ray apparatus such that X-ray beams output therefrom are directed through a target at an image receptor 1 100.
  • the aiming apparatus 800A in Fig. 9 is similar to the aiming apparatus 800, but has an additional, "middle" ring 850 connected to the first 810 and second 830 rings.
  • the rings 810, 830, 850 of the aiming apparatus 800A can be substantially the same size and generally of the same shape, or can have different sizes and/or shapes.
  • the rings 810, 830, 850 also can include indicia indicating an order of use. Portions of the rings 810, 830, 850 may overlap others of the rings. Since each of the rings 810, 830, 850 is made of a material that is transparent to X-rays, the overlapping will have little or no effect on images produced.
  • the middle ring 850 can define an aiming direction 855 that is between the directions 815 and 835 of the first and second rings 810 and 830.
  • the aiming direction 855 may bisect the angle between the extreme aiming directions 815 and 835.
  • the extreme rings 810, 830 may define aiming directions that are between about ten and twenty degrees apart.
  • the aiming directions 815, 835, 855 may be selected so that once the aiming apparatus 800A is coupled to a support arm 900 the clinician can aim an X-ray apparatus using the arrangement of the rings to take radiographs at the respective different angles.
  • the radiographs may be taken at predetermined, reproducible angles and the clinician does not have to move or otherwise reposition the aiming apparatus 800A to take radiographs at different angles.
  • Either of the outer rings 810 or 830 can be arranged (i.e., coupled to support arm 900) such that an axis 815, 835, 855 passing through the center of a respective ring 810, 830, 850 forms any desired angle, such as orthogonal or substantially orthogonal, with respect to a receiving surface 1 102 of an image receptor 1 100. Consequently, the axes of the other of the outer rings and the aiming direction 855 of the middle ring 850 may be perpendicular or oblique to the receiving surface 1 102. In other embodiments, the aiming directions defined by the rings 815, 835, 855 are all oblique to the receiving surface 1 102.
  • aiming apparatuses 800, 800A discussed above have been described as being arranged in a "horizontal" orientation (i.e., radiographs are taken at angles displaced from each other in a general horizontal direction).
  • aiming apparatuses similar to 800, 800A of Figs. 8 and 9 also may be configured to define separation angles that lie in planes that contain (or are parallel to) a root axis of a target tooth. The aiming directions defined thereby may form any chosen angle with respect to the receiving surface 1 102.
  • Embodiments of the disclosed subject matter also include an aiming apparatus that can provide for both vertical and horizontal orientations

Abstract

L'invention porte sur des dispositifs, sur des procédés et sur des systèmes pour la conception, la fabrication, la modification et l'implantation de prothèses dentaires. Un implant est créé et a une forme se conformant étroitement ou précisément à la forme naturelle d'une alvéole dentaire modifiée ou non modifiée. L'implant est utilisé pour ancrer sur un os n'importe laquelle d'une diversité de restaurations dentaires ou autres dispositifs de substitution. De plus, l'invention porte sur des procédés, des systèmes et des appareils pour prendre des radios à des angles spécifiques, standard et/ou reproductibles. Une première radio est prise, à l'aide d'un appareil de visée, de telle manière que la direction de visée formant un premier angle avec la normale à un plan d'image d'un récepteur d'image. Au moins une radio supplémentaire est prise, à l'aide de l'appareil de visée, avec des directions de visée différentes de la première direction. Des radios prises avec les multiples angles de visée sont utilisées pour créer une image tridimensionnelle d'un objet représenté par les radios.
EP10821246A 2009-10-01 2010-09-30 Procédés, systèmes, appareils et dispositifs de diagnostic dentaire et de restauration dentaire Withdrawn EP2482754A4 (fr)

Applications Claiming Priority (3)

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US24768909P 2009-10-01 2009-10-01
US24772609P 2009-10-01 2009-10-01
PCT/US2010/050887 WO2011041530A1 (fr) 2009-10-01 2010-09-30 Procédés, systèmes, appareils et dispositifs de diagnostic dentaire et de restauration dentaire

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EP2482754A1 true EP2482754A1 (fr) 2012-08-08
EP2482754A4 EP2482754A4 (fr) 2013-03-27

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US (1) US20120308963A1 (fr)
EP (1) EP2482754A4 (fr)
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US20120308963A1 (en) 2012-12-06
WO2011041530A1 (fr) 2011-04-07

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